• Christopher T Stephens, Stephanie Kahntroff, and Richard P Dutton.
• Division of Trauma Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
• Anesth. Analg. 2009 Sep 1;109(3):866-72.

BackgroundEmergency airway management is a required skill for many anesthesiologists. We studied 10 yr of experience at a Level 1 trauma center to determine the outcomes of tracheal intubation attempts within the first 24 h of admission.MethodsWe examined Trauma Registry, quality management, and billing system records from July 1996 to June 2006 to determine the number of patients requiring intubation within 1 h of hospital arrival and to estimate the number requiring intubation with the first 24 h. We reviewed the medical record of each patient in either cohort who underwent a surgical airway access procedure (tracheotomy or cricothyrotomy) to determine the presenting characteristics of the patients and the reason they could not be orally or nasally intubated.ResultsAll intubation attempts were supervised by an anesthesiologist experienced in trauma patient care. Rapid sequence intubation with direct laryngoscopy was the standard approach throughout the study period. During the first hour after admission, 6088 patients required intubation, of whom 21 (0.3%) received a surgical airway. During the first 24 h, 10 more patients, for a total of 31, received a surgical airway, during approximately 32,000 attempts (0.1%). Unanticipated difficult upper airway anatomy was the leading reason for a surgical airway. Four of the 31 patients died of their injuries but none as the result of failed intubation.ConclusionsIn the hands of experienced anesthesiologists, rapid sequence intubation followed by direct laryngoscopy is a remarkably effective approach to emergency airway management. An algorithm designed around this approach can achieve very high levels of success.

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